Atopic Dermatitis: Disparities in Cost and Access to Skin Care Treatments
New research underscores a critical dimension in the management of atopic dermatitis (AD): the intersection of gentle skin care, affordability, and equitable access to recommended products. Atopic dermatitis, a chronic inflammatory skin condition marked by pruritus and disrupted skin barrier function, demands consistent use of gentle cleansers and moisturizers to mitigate flares and maintain remission. However, a new analysis reveals that the costs associated with dermatologist-recommended products and the structural limitations of retail pharmacy distribution may disproportionately burden patients in lower-income communities, widening disparities in AD outcomes.
The study compared the price of products endorsed by the National Eczema Association (NEA)—which include formulations vetted for minimal irritation and superior barrier support—to more popularly purchased over-the-counter options. The findings were striking: NEA-recommended moisturizing lotions averaged $2.72 per ounce compared to $1.13 per ounce for commonly chosen alternatives. Similarly, recommended liquid body soaps averaged $1.30 per ounce, nearly four times the $0.35 per ounce cost of typical purchases. These price differences were consistent across major retailers including Amazon, Walmart, Walgreens, CVS, Target, and Meijer. This suggests that adherence to dermatologist-preferred skin care regimens may be financially challenging for many patients, particularly given the daily, lifelong nature of AD management.
Beyond the individual financial strain, the study also explored geographic and structural barriers to accessing these products by examining pharmacy availability in low- versus high-income zip codes in Chicago and New York. The data revealed stark contrasts. In Chicago, there were only 0.26 retail pharmacies per 10,000 residents in low-income neighborhoods compared to 3.20 in higher-income areas. Similarly, in New York, the disparity was 0.26 versus 2.90 pharmacies per 10,000 residents. These so-called “pharmacy deserts” translate to longer travel distances and fewer points of access for obtaining necessary skin care products.
Even when pharmacies were present in low-income neighborhoods, they operated under additional constraints. Stores in these areas had shorter hours—averaging 14.9 versus 19.2 hours of daily operation in Chicago, and 13.3 versus 21.0 hours in New York—potentially limiting patient flexibility to purchase products outside of work hours. Moreover, these pharmacies stocked significantly fewer units of recommended skin care products, with average inventory counts approximately half of those found in wealthier neighborhoods.
Collectively, these findings highlight how both economic and structural inequities compound the burden of AD. Patients in lower-income areas face a triple challenge: higher relative costs for evidence-based skin care, reduced local availability of pharmacies that carry such products, and limited operating hours that may restrict access for working families. For clinicians, this underscores the importance of tailoring skin care recommendations with cost and accessibility in mind, recognizing that even well-intentioned, guideline-driven advice can inadvertently contribute to disparities if patients cannot reasonably procure the recommended products.
Moving forward, these insights also have implications for public health and policy. Efforts to expand pharmacy networks in underserved areas, incentivize stock of dermatologist-recommended products, and support affordability initiatives—such as coupons or insurance coverage for emollients—could play a critical role in mitigating these disparities. As atopic dermatitis prevalence continues to rise, addressing these socioeconomic barriers will be essential not only for improving individual patient outcomes but also for advancing health equity on a broader scale.